Autor: ---- Fuente: The Medical Institute


S. Liliana Escobar-Chaves, DrPH
Susan Tortolero, PhD
Christine Markham, PhD
Barbara Low, DrPH

Center for Health Promotion and Prevention Research
University of Texas Health Science Center Houston

Submitted to:

Centers for Disease Control and Prevention

Grant # H75/CCH623007-01-1

Funding for this study was included as a congressional project in the fiscal year 2003 appropriation for the Centers for Disease Control and Prevention. The relevant portion of House Report 108-10 reads as follows: “The conferees include the following amounts for the following projects and activities in fiscal year 2003: Medical Institute for Sexual Health; $250,000.”

Executive Summary

Adolescents in the United States are engaging in sexual activity at early ages and with multiple partners. Approximately 46% of high school students have had sexual intercourse – 6.6% of these before the age of 13, and 14% with four or more sexual partners.1 Sexually active adolescents are at immediate risk for pregnancy and acquiring sexually transmitted infections (STIs) and are also at risk for depression and suicide. Each year nearly 900,000 teenage girls in the US become pregnant – 340,000 are 17 or younger – and 35% of American teenage girls have been pregnant at least once by age 20.2 In the United States the risk of acquiring an STI is higher among teenagers that among adults.3

A critical review of the scientific literature and other sources shows that one largely unexplored factor that may contribute to adolescent sexual activity is their exposure to the mass media.

The average American youth spends one-third of each day with various forms of mass media, mostly without parental oversight.4

The mass media have been shown to affect a broad range of adolescent attitudes and behaviors, including violence, eating disorders, and tobacco and alcohol use.

Few studies have examined the effects of mass media on adolescent sexual attitudes and behavior.

An extensive, systematic review of the relevant biomedical and social science literature shows that only 19 of 2,522 research-related documents (<1%) involving media and youth address the effects of mass media on adolescent sexual attitudes and behavior (Appendix 1).

Television, Cable TV, and Music Videos

Exposure: The average teenager spends 3 to 4 hours per day watching television.4

Content: For every hour of programming watched by adolescents, an average of 6.7 scenes included sexual topics5 and about 10% of scenes show portray couples engaging in sexual intercourse.6-8 One-third of shows with sexual content involve teen characters.5-8

Effects: Several studies suggest an association between media exposure and adolescent sexual behavior, but they are limited because of their study designs, sampling procedures, and small sample sizes. We do not know the relationship over time between exposure to television and sexual initiation in adolescents. The only study in this area is a secondary analysis of data collected for other purposes. As such, it lacks a rigorous measurement methodology to accurately examine the effects, if any.9

Adolescents exposed to TV with sexual content are more likely than other adolescents to:

· Overestimate the frequency of some sexual behaviors10

· Have more permissive attitudes toward premarital sex11

· Think that having sex is beneficial.12


Exposure: Two-thirds of Hollywood movies made each year are R-rated and most young people have viewed these movies before they reach the required age of 16.13 “In the only study involving exposure and effects of adult oriented movies (note that the study itself refers to “X-rated” movies), 30% of minority adolescent females said they had seen an NC-17 rated movie 3 months prior to the survey.14

Content: Two studies have analyzed the content of the top movie video rentals and R-rated movies frequently viewed by youth.13,15 Both studies reported a high amount of sexual content with the most common sexual activity being intercourse between unmarried partners.

Effects: Adolescents who are exposed to NC-17 rated movies are more likely to:

· Have multiple sexual partners

· Have sex more frequently

· Test positive for chlamydia

· Have more negative attitudes toward using condoms

· Not use contraceptives14

We do not know if the sexual content of R-rated movies has comparable effects.


Exposure: Adolescents listen to radio nearly 40 hours a week.16

Content: 22% of teen-oriented radio segments contain sexual content; 20% of these were “pretty explicit” or “very explicit.”17

Effects: We do not know the effect of exposure to radio on adolescent sexual attitudes and behaviors.


Exposure: Teenagers spend an average of over 20 hours per week listening to music.4

Content: 42% of the top-selling CDs in 1999 contain sexual content; 41% of these were “pretty explicit” or “very explicit.” 17

Effects: We do not know the impact of sexually explicit lyrics on adolescent sexual attitudes and behaviors.


Exposure: 85% of teens have read or looked at a magazine in the last 6 months.18

Content: There are few scientific data on the content of the magazines adolescents read.

Effects: We do not know the impact of sexually explicit magazines or of “mainstream” publications on adolescent sexual attitudes and behaviors.


Exposure: The average American child sees an estimated 20,000 advertisements each year. By age 19 the average American adolescent has absorbed nearly 300,000 advertisements.19

Content: American teens currently spend about $153 billion per year, an average of $89 per week per teen.20 Therefore, they comprise a specific target audience for much consumer advertising.

Nontraditional advertising messages that feature embedded and subtle messaging (such as product placement) are more influential, appealing, and effective with teens than more overt approaches.21 However, there is little scientific data about the implicit and explicit content of either overt or embedded advertising.

Effects: We do not know the impact of the sexual content of advertising on adolescent sexual attitudes and behaviors.

Video and Computer Games

Exposure: 70% of households surveyed in 1999 reported having a video game system.4

Content: There are no systematic data concerning the sexual content of computer, video, and Internet games most popular with adolescents.

Effects: We do not know the impact of the sexual content of video and computer games on adolescent sexual attitudes and behaviors.

The Internet

Exposure: On average, children 9–17 years old use the Internet 4 days per week and spend almost 2 hours online at a time.22

61% of teens using computers “surf the net,” and 14% report “seeing something they wouldn’t want their parents to know about.”23

60% of youth report accessing chat rooms and web sites, mainly alone.4

Content: While pornography is widely available on the Internet, there are no systematic data concerning the sexual content of those sites visited by adolescents.

Effects: We do not know the impact of sexual content on the Internet on adolescent sexual attitudes and behaviors.

Gaps in knowledge

Several gaps have been identified:

We do not know the extent of sexual content in radio, advertising, magazines, the Internet, or chat rooms.

We do not know the extent of adolescents’ exposure to such content. There is a notable scarcity of well-conducted, scientifically rigorous studies that examine the impact of sexual content in the media on adolescent sexual attitudes and behaviors.

There are no studies that have examined the cumulative effects of sexual content in different types of media over time on developing youth.

Future Directions

Based on this review of the scientific literature, studies are needed to

Refine methodologies to measure mass media exposure and exposure to sexual content in the media.

Survey adolescents to determine their exposure to forms of mass media for which data are lacking and also survey parents to assess the effectiveness of parental involvement, communication, supervision, and monitoring of media sexual content on these adolescent exposures. Findings from these initial short-term (cross-sectional) studies can be used to guide longer term (longitudinal) studies to assess the impact of exposure on adolescents’ attitudes, values, and sexual risk behaviors.

Evaluate effects of mass media on child and adolescent sexual attitudes and behaviors over time (longitudinal studies).

Evaluate child, adolescent, and parent media literacy programs to determine best-practice interventions and their impact on youth viewing choices, interpretation of content, behavioral intentions, and subsequent risk-taking behaviors.

Evaluate the effectiveness of current technological, socio-behavioral, and media practices in to limiting exposure of youth to sexual content in the media


1. Grunbaum JA, Kann L, Kinchen SA, Williams B, Ross JG, Lowry R, Kolbe L. Youth risk behavior surveillance--United States, 2001. Morb Mortal Wkly Rep 2002 Jun;51(ss 4):1-62.

2. Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in pregnancy rates for the United States, 1976-97: An update. National Vital Statistics Reports 49[4]. 2001.

3. Centers for Disease Control and Prevention (CDC), National Center for HIV, STD, and TB Prevention, Division of STD Prevention. Sexually Transmitted Disease Surveillance, 2000. .

4. Roberts DF. Media and youth: Access, exposure, and privatization. J Adolesc Health 2000 Aug;27(2 Suppl):8-14.

5. Kunkel D, Biely E, Eyal K, Cope-Farrar K, Donnerstein E, Fandrich R. Sex on TV 3: A biennial report of the Kaiser Family Foundation. 2003.

6. Johnson T. The 'family hour': No place for your kids. Parents Television Council; Media Research Center. 1997.
PTC/publications/reports/archives/famhtm.asp. 5-8-1997. 1-15-2004.

7. Kunkel D, Cope-Farrar K, Biely E, Farinola WJM, Donnerstein E. Sex on TV 2: A biennial report to the Kaiser Family Foundation. 2001.

8. Cope-Farrar KM, Kunkel D. Sexual messages in teens' favorite prime-time television programs. In: Brown JD, Steele JR, Walsh-Childers K, editors. Sexual Teens, Sexual Media: Investigating Media's influence on adolescent sexuality. Mahwah, N.J.: Lawrence Erlbaum Associates; 2002. p 59-78.

9. Peterson JL, Moore KA, Furstenberg FF. Television viewing and early initiation of sexual intercourse: Is there a link? J Homosex 1991;21(1-2):93-118.

10. Davis S, Mares M-L. Effects of talk show viewing on adolescents. J Commun 1998;48(3):69-86.

11. Greeson LE, Williams RA. Social implications of music videos on youth: An analysis of the content and effects of MTV. Youth Soc 1986;18:177-89.

12. Knight MG. Mass media, sexual attitudes and sexual behaviors among teens [dissertation]. University of North Carolina Chapel Hill, School of Journalism and Mass Communication; 2000. Available from: Available from UMI, Microform # 9968620 (226 pp.); Dissertation Abstracts International 2000-95019-047.

13. Greenberg BS, Siemicki M, Dorfman S, Heeter C, Stanley C, Soderman A, Linsangan R. Sex content in R-rated films viewed by adolescents. In: Greenberg BS, Brown JD, Buerkel-Rothfuss N, editors. Media, Sex and the Adolescent. Cresskill, NJ: Hampton Press; 1993. p 45-58.

14. Wingood GM, DiClemente RJ, Harrington K, Davies S, Hook EW, Kim OM. Exposure to X-rated movies and adolescents' sexual and contraceptive-related attitudes and behaviors. Pediatrics 2001 May;107(5):1116-9.

15. Dempsey JM, Reichert T. Portrayal of married sex in the movies. J Sex Cult 2000;4(3):21-36.

16. Klein JD, Brown JD, Childers KW, Oliveri J, Porter C, Dykers C. Adolescents' risky behavior and mass media use. Pediatrics 1993 Jul;92(1):24-31.

17. Gentile DA. Teen-oriented radio and CD sexual content analysis. National Institute on Media and the Family. 1999.

18. Simmons Market Research Bureau. Simmons Teen. 2000. Available by subscription only, 230 Park Avenue, New York, NY 10003. Summary provided by Patricia Eitel of Ogilvy.

19. Zollo P. Getting Wiser to Teens: More Insights into Marketing to Teenagers. 3rd ed. New Strategist; 2003.

20. Brown JD. Adolescents' sexual media diets. J Adolesc Health 2000 Aug;27(2 Suppl):35-40.

21. A Day in the Life of a Teen: A Diary Approach to Getting the Inside Information [audiovisual presentation] [PowerPoint presentation; 41 slides]. Office of National Drug Control Policy, Ogilvy. New York: Ogilvy; 2003.

22. American Academy of Pediatrics, Committee on Public Education, American Academy of Child and Adolescent Psychiatry, American Psychological Association. Sexuality, contraception, and the media. Pediatrics 2001 Jan;107(1):191-4.

23. Strasburger VC, Donnerstein E. Children, adolescents, and the media in the 21st century. Adolesc Med 2000 Feb;11(1):51-68.
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